Management Liability
Business Name
*
Business Address
Description of business activities
Number of years in business
Contact Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
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Annual Turnover
Number of Employees
Entity Type
Please Select
Company
Sole Trader
Partnership
Limit of Indemnity
Please Select
$1,000,000
$2,000,000
$3,000,000
$5,000,000
$10,000,000
Other
Have you sustained any management liability claims in the past 5 years? Including claims against directors or officers, fees or penalties, attendances or inquiries, claims from employees, tax audits or similar?
Yes
No
Are there any other facts that an insurer should be aware of?
Yes
No
If yes to either of the above two questions, please advise details:
Submit
Should be Empty: